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中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 546 -549. doi: 10.3877/cma.j.issn.1674-3946.2021.05.022

论著

腹腔镜下腹会阴直肠癌手术中两种乙状结肠造口的临床比较
李关宁1, 杨俊杰1, 杨振淮1,()   
  1. 1. 510130 广州医科大学附属中医医院外科
  • 收稿日期:2020-07-08 出版日期:2021-10-26
  • 通信作者: 杨振淮

Comparative study of two different sigmoidostomy in laparoscopic abdominoperineal resection of rectal cancer

Guanning Li1, Junjie Yang1, Zhenhuai Yang1,()   

  1. 1. Department of Surgery, Affiliated TCM Hospital of Guangzhou Medical University, Guangdong 510130, China
  • Received:2020-07-08 Published:2021-10-26
  • Corresponding author: Zhenhuai Yang
  • Supported by:
    Guangdong Provincial Project of Scientific Research program of Bureau of Traditional Chinese Medicine(20162116)
引用本文:

李关宁, 杨俊杰, 杨振淮. 腹腔镜下腹会阴直肠癌手术中两种乙状结肠造口的临床比较[J/OL]. 中华普外科手术学杂志(电子版), 2021, 15(05): 546-549.

Guanning Li, Junjie Yang, Zhenhuai Yang. Comparative study of two different sigmoidostomy in laparoscopic abdominoperineal resection of rectal cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(05): 546-549.

目的

对比腹腔镜下腹会阴直肠癌手术中两种乙状结肠造口的临床效果。

方法

回顾性队列研究2017年5月至2020年3月在接受腹腔镜下腹会阴直肠癌手术的81例患者临床资料,根据术中乙状结肠造口方式不同分为腹膜外组(经腹膜外造口,36例)、腹膜内组(经腹膜内造口,45例),采用SPSS23.0软件进行处理,围术期指标等以(±s)表示,独立t检验;排便功能、Kirwan失禁分级、术后并发症等用χ2检验或秩和检验,P<0.05为差异有统计学意义。

结果

腹膜外组手术时间、术后首次排气、排便时间、术后住院时间和术中出血量均少于腹膜内组(P<0.05);腹膜外组术后排便功能总优良率(80.6%)比腹膜内组(60.0%)高(P<0.05)、术后Kirwan失禁分级比腹膜内组轻(P<0.05);腹膜外组术后并发症发生率(8.3%)比腹膜内组(26.7%)低(P<0.05)。

结论

相比经腹膜内乙状结肠造口,腹腔镜下腹会阴直肠癌手术中经腹膜外造口更利于加快术后康复进程,减少造口并发症,且患者排便、控便能力更好,安全性更高。

Objective

To compare the clinical outcome of two different sigmoidostomy in laparoscopic abdominoperineal resection (LAPR) of rectal cancer.

Methods

From May 2017 to March 2020, the clinical data of 81 patients underwent LAPR were analyzed retrospectively, who were divided into the extraperitoneal group (extraperitoneal stoma, 36 cases), and the intraperitoneal group (intraperitoneal stoma, 45 cases). Statistical analysis were performed by using SPSS23.0 software. The perioperative indicators were expressed as (±s), and were examined by using independent t test. Defecation function, Kirwan incontinence classification for postoperative complications were analyzed by using χ2 test or the rank sum test. A P value of <0.05 was considered as statistically significant difference.

Results

The operation time, first postoperative exhaust, defecation time, the time of postoperative hospitalization and intraoperative bleeding in the extraperitoneal group were less than those in the intraperitoneal group respectively (P<0.05). The excellent rate of 80.6% of postoperative defecation in the extraperitoneal group was higher than 60.0% in the intraperitoneal group (P<0.05). The Kirwan incontinence grade in the extraperitoneal group was lighter than that in the intraperitoneal group (P<0.05). The incidence of 8.3% of postoperative complications was lower in the extraperitoneal group than 26.7% in the intraperitoneal group (P<0.05).

Conclusion

Compared with intraperitoneal sigmoidostomy, extraperitoneal sigmoidostomy is more safe and effective with rapid postoperative rehabilitation, reduced the complications and improved control of defecation.

表1 81例直肠癌患者术中不同乙状结肠造口两组一般资料对比[(±s),例]
表2 81例直肠癌患者术中不同乙状结肠造口两组围术期指标对比(±s)
表3 81例直肠癌患者术中不同乙状结肠造口两组排便功能对比(例)
表4 81例直肠癌患者术中不同乙状结肠造口两组Kirwan失禁分级对比[例(%)]
表5 81例直肠癌患者术中不同乙状结肠造口两组术后并发症对比(例)
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